The chronic care model and relationships to patient health status and health-related quality of life.
BACKGROUND
The chronic care model (CCM) is a system-level framework used to guide quality improvement efforts in health care. However, little is known about its relationship to patient-level health measures. This study describes the implementation of the CCM as adapted for prevention and health behavior counseling in primary care practices, and examines relationships between the CCM and patient health measures, including general health status and health-related quality of life (HRQOL).


METHODS
Baseline data from Round 2 of the Prescription for Health initiative (2005-2007) were used to assess CCM implementation in 57 practices located nationwide. Relationships between the CCM and three separate measures of health among 4735 patients were analyzed in 2007. A hierarchical generalized linear modeling approach to ordinal regression was used to estimate categories of general health status, unhealthy days, and activity-limiting days, adjusting for patient covariates and clustering effects.


RESULTS
Outcome variances were significantly accounted for by differences in practice characteristics (p<0.001). Practices that used individual or group planned visits were more likely to see patients in lower health categories across all measures (OR=0.74-0.81, p<0.05). Practices that used patient registries, health promotion champions, evidence-based guidelines, publicly reported performance measures, and support for behavior change were associated with higher patient health levels (OR=1.28-1.98, p<0.05).


CONCLUSIONS
A practice's implementation of the CCM was significantly related to patient health status and HRQOL. Adapting the CCM for prevention may serve to reorient care delivery toward more proactive behavior change and improvements in patient health outcomes.
Hung
Dorothy Y
DY
Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York 10032, USA. dh2237@columbia.edu
Glasgow
Russell E
RE
Dickinson
L Miriam
LM
Froshaug
Desireé B
DB
Fernald
Douglas H
DH
Balasubramanian
Bijal A
BA
Green
Larry A
LA
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003625:Data Collection; D037001:Directive Counseling / Q000379:methods; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D011314:Preventive Health Services / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D011788:Quality of Life; D014481:United States; D055815:Young Adult